Part 86, page 54
Document date 8 February 1973
FBI 164-81, Vault Part 86 p. 54 (DB Cooper-37898), Form, dated 8 Feb 1973 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/54
Transcript
The scan is the source; the transcript is machine-generated from it.
NORTHERN VIRGINIA DOCTORS HOSPITAL No. 2799 EMERGENCY ROOM RECORD [guess: Admitted] 324 6 E.S. or H.I.L. No. ☐ Medicare Patient
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Last Name: [redacted] First Name: [redacted] Middle Name: [redacted] Home Phone: [redacted] Admission Date: 2/8/73 Date of Birth: [redacted] Sex: [redacted] Civil Status: [illegible] Religion: [illegible] Address: [redacted] [guess: Sylvander Lake] Arlington, VA [redacted] Name of Blue Cross and/or Blue Shield: [redacted] Other hospitalization insurance: [illegible] Policy No: [redacted] Group No: [illegible] Contract No: [guess: col] 1110-6 Effective Date: 6/1/72 Subscriber: [redacted] ☐ Compensation Effective Date: [illegible]
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EMERGENCY ROOM CHARGES Does Not Include Fee of Attending Physician
ITEM | CHARGE | ITEM | CHARGE Emergency Room | | Sutures | Anesthetic | | Tetanus Antitoxin | Central Supply | | Cast | Dressings | | E.O.M. | Drugs | | | Oxygen | | |
OTHER SERVICES RENDERED X-ray _____ b6 Laboratory _____ b7C Physical Therapy _____ EKG _____
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no known allergies to drugs. BRIEF HISTORY In [illegible] case where, when and how [was] injured, if illness, [describe]: Pt. [guess: having] acute pain in both lower [guess: limbs] [guess: especially] lt. [guess: axis] which [guess: began] this [guess: morning] + has become [guess: progressively] worse.
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PHYSICIAN'S REPORT CONDITION ON ADMISSION Good ☐ Fair ☐ Poor ☐ Shock ☐ Hemorrhage ☐ Coma ☐ Temp. 98.6 [guess: Oral] Pulse 100 R 24 BP [guess: 150/80] Treatment: Tetanus Toxoid _____ Tetanus Antitoxin _____ Tetanus Antitoxin _____
[guess: Diagnosis]: Thromb[guess: o]phlebitis
Disposition of Case: [guess: To be admitted] Referred to Dr. _____ Date: 7/[guess: 8]/73
INSTRUCTIONS TO PATIENT:
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DB Cooper-37898
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b6 b7C